Bipolar Depression Rating Scale (BDRS)

INSTRUCTIONS: “I am going to ask you some questions about symptoms you may have. When
answering please keep in mind that we are focusing only on how you are now, or have been over the
last few days.”

Check or tick () one answer for each of the questions below.

1. DEPRESSED MOOD
Self-reported and/or observed depression as evidenced by gloom, sadness, pessimism, hopelessness, and
helplessness

☐0 Nil
☐1 Mild [brief or transient periods of depression, or mildly depressed mood]
☐2 Moderate [depressed mood is clearly but not consistently present and other emotions are
expressed, or depression is of moderate intensity]
☐3 Severe [pervasive or continuous depressed mood of marked intensity]

2. SLEEP DISTURBANCE: score either A or B

Change in total amount of sleep over a 24-hour cycle, rated independent of the effect of external factors

A: Insomnia (reduction in total sleep time)

☐0 Nil
☐1 Mild [up to 2 hours]
☐2 Moderate [2 – 4 hours]
☐3 Severe [more than 4 hours]

OR

B: Hypersomnia (increase in total sleep time, inclusive of daytime sleep)

☐0 Nil
☐1 Mild [less than 2 hours, or normal amount but non-restorative]
☐2 Moderate [greater than 2 hours]
☐3 Severe [greater than 4 hours]

3. APPETITE DISTURBANCE: score either A or B

Change in appetite and food consumption, rated independent of the effect of external factors

A. Loss of appetite

☐0 Nil
☐1 Mild [no change in food intake, but has to push self to eat or reports that food has lost taste]
☐2 Moderate [some decrease in food intake]
☐3 Severe [marked decrease in food intake, hardly eating]

OR

B. Increase in appetite

☐0 Nil
☐1 Mild [no change in food intake, but increased hunger]
☐2 Moderate [some increase in food intake, e.g., comfort eating]
☐3 Severe [marked increase in food intake or cravings]
4. REDUCED SOCIAL ENGAGEMENT
Reports reduced social and interpersonal engagement or interactions

☐0 Nil [normal]
☐1 Mild [slight reduction in social engagement with no impairment in social or interpersonal
function]
☐2 Moderate [clear reduction in social engagement with some functional sequelae, e.g., avoids
some social engagements or conversations]
☐3 Severe [marked reduction in social interaction or avoidance of almost all forms of social
contact, e.g., refuses to answer the phone or see friends or family]

5. REDUCED ENERGY AND ACTIVITY

Reduced energy, drive and goal directed behavior

☐0 Nil
☐1 Mild [able to engage in usual activities but with increased effort]
☐2 Moderate [significant reduction in energy leading to reduction of some role-specific activities]
☐3 Severe [leaden paralysis or cessation of almost all role specific activities, e.g., spends
excessive time in bed, avoids answering the phone, poor personal hygiene]

6. REDUCED MOTIVATION
Reports of subjective reduction in drive, motivation, and consequent goal directed activity

☐0 Nil [normal motivation]

☐1 Mild [slight reduction in motivation with no reduction in function]
☐2 Moderate [reduced motivation or drive with significantly reduced volitional activity or requires
substantial effort to maintain usual level of function]
☐3 Severe [reduced motivation or drive such that goal directed behaviour or function is markedly
reduced]

7. IMPAIRED CONCENTRATION AND MEMORY

Subjective reports of reduced attention, concentration, or memory, and consequent functional impairment

☐0 Nil
☐1 Mild [slight impairment of attention, concentration, or memory with no functional impairment]
☐2 Moderate [significant impairment of attention, concentration, or forgetfulness with some
functional impairment]
☐3 Severe [marked impairment of concentration or memory with substantial functional impairment,
e.g., unable to read or watch TV]

8. ANXIETY
Subjective reports of worry, tension, and/or somatic anxiety symptoms e.g., tremor, palpitations, dizziness,
light-headedness, pins and needles, sweating, , butterflies in the stomach,

☐0 Nil
☐1 Mild [transient worry or tension about minor matters]
☐2 Moderate [significant anxiety, tension, or worry, or some accompanying somatic features]
☐3 Severe [marked continuous anxiety, tension, or worry that interferes with normal activity; or
panic attacks]

9. ANHEDONIA
Subjectively reduced ability to experience pleasure in usual activities

☐0 Nil
☐1 Mild [slight reduction in pleasure from usually pleasurable activities]
☐2 Moderate [significant reduction in pleasure from usually pleasurable activities; some pleasure
from isolated activities retained]
☐3 Severe [complete inability to experience pleasure]
10. AFFECTIVE FLATTENING
Subjective sense of reduced intensity or range of feelings or emotions

☐0 Nil
☐1 Mild [slight constriction of range of affect, or transient reduction in range or intensity of feelings]
☐2 Moderate [significant constriction of range or intensity of feelings with preservation of some
emotions, e.g., unable to cry]
☐3 Severe [marked and pervasive constriction of range of affect or inability to experience usual
emotions]

11. WORTHLESSNESS
Subjective sense, or thoughts, of decreased self-value or self-worth

☐0 Nil
☐1 Mild [slight decrease in sense of self-worth]
☐2 Moderate [some thoughts of worthlessness and decreased self-worth]
☐3 Severe [marked, pervasive, or persistent feelings of worthlessness, e.g., feels others better off
without them, unable to appreciate positive attributes]

12. HELPLESSNESS AND HOPELESSNESS

Subjective sense of pessimism or gloom regarding the future, inability to cope, or sense of loss of control

☐0 Nil
☐1 Mild [occasional and mild feelings of not being able to cope as usual; or pessimism]
☐2 Moderate [often feels unable to cope, or significant feelings of helplessness or hopelessness
which lift at times]
☐3 Severe [marked and persistent feelings of pessimism, helplessness, or hopelessness]

13. SUICIDAL IDEATION

Thoughts or feelings that life is not worthwhile; thoughts of death or suicide

☐0 Nil
☐1 Mild [thoughts that life is not worthwhile or is meaningless]
☐2 Moderate [thoughts of dying or death, but with no active suicide thoughts or plans]
☐3 Severe [thoughts or plans of suicide]

14. GUILT
Subjective sense of self blame, failure, or remorse for real or imagined past errors

☐0 Nil
☐1 Mild [slight decrease in self-esteem or increased self-criticism]
☐2 Moderate [significant thoughts of failure, self-criticism, inability to cope, or ruminations
regarding past failures and the effect on others; able to recognise as excessive]
☐3 Severe [marked, pervasive, or persistent guilt, e.g., feelings of deserving punishment; or does
not clearly recognise as excessive]

15. PSYCHOTIC SYMPTOMS

Presence of overvalued ideas, delusions, or hallucinations

☐0 Nil [absent]
☐1 Mild [mild overvalued ideas, e.g., self-criticism or pessimism without clear effect on behaviour]
☐2 Moderate [significant overvalued ideas with clear effect on behaviour, e.g., strong guilt feelings,
clear thoughts that others would be better off without them]
☐3 Severe [clear psychotic symptoms, e.g., delusions or hallucinations]
16. IRRITABILITY
Reports uncharacteristic subjective irritability, short fuse, easily angered, manifested by verbal or physical
outbursts

☐0 Nil
☐1 Mild [slight subjective irritability; may not be overtly present]
☐2 Moderate [verbal snappiness and irritability that is clearly observable in interview]
☐3 Severe [reports of physical outbursts, e.g., throwing/breaking objects, or markedly abusive
verbal outbursts]

17. LABILITY
Observed mood lability or reported mood swings

☐0 Nil
☐1 Mild [subjective reports of mild increase in mood lability]
☐2 Moderate [mood lability clearly observable, moderate in intensity]
☐3 Severe [marked and dominant mood lability, frequent or dramatic swings in mood]

18. INCREASED MOTOR DRIVE

Subjective reports and objective evidence of increased motor drive and motor activity

☐0 Nil [normal motor drive]

☐1 Mild [slight increase in drive, not observable in interview]
☐2 Moderate [clear and observable increase in energy and drive]
☐3 Severe [marked or continuous increase in drive]

19. INCREASED SPEECH

Observed increase in either the rate or quantity of speech, or observed flight of ideas

☐0 Nil
☐1 Mild [slight increase in the rate or quantity of speech]
☐2 Moderate [racing thoughts, significantly more talkative, clearly distractible, or some
circumstantiality; does not impede interview]
☐3 Severe [flight of ideas; interferes with interview]

20. AGITATION
Observed restlessness or agitation

☐0 Nil [normal]
☐1 Mild [slight restlessness]
☐2 Moderate [clear increase in level of agitation]
☐3 Severe [marked agitation, e.g., near continuous pacing or wringing

hands] TOTAL #